Hospitalists embedded with trauma service improve patient care

Christiana Care is one of the nation’s first health care systems to embed hospitalists in the trauma service. A new study is showing that the program, begun in January 2013, is reducing patient mortality and 30-day trauma-related hospital readmissions for patients with multiple co-morbidities.

In January, Mark D. Cipolle, M.D., Ph.D., FACS, FCCM, director of outcomes research for Christiana Care’s Surgical Services service line, reported on the results of the hospitalist program at the Eastern Association for the Surgery of Trauma (EAST) in San Antonio. Dr. Cipolle described a retrospective analysis of 469 patients who were co-managed by a hospitalist from December 2013 to November 2014, and 938 patients who did not have a hospitalist as part of the trauma care team.

“Our evidence suggests that hospitalists offer a great deal of value when embedded in a surgical service to co-manage patients with multiple comorbidities,” Dr. Cipolle said. “Patients seen with a hospitalist as part of the team had fewer trauma-related hospital readmissions (0.6 percent vs. 2.4 percent) and lower patient mortality rates (2.9 percent vs. 0.4 percent).”

The study also showed that patients seen by the hospitalist group had longer hospital stays (median of 3.5 days vs. 5 days) and more upgrades to the intensive care unit (2.1 percent of patients vs. 4.3 percent) when compared with the nonhospitalist group.

Hospitalist Erin M. Meyer, D.O., FAWM, FAAP, FACP, SFHM, said many of the trauma admissions involve older adults who arrive after a fall and have complex medical issues, such as chronic kidney disease, diabetes and hypertension. Often during a patient’s stay, a hospitalist will address these conditions so patients are discharged with their chronic diseases at baseline or sometimes under better control than when they arrived. Dr. Meyer also believes the program strengthens communication within the treatment team.

“The important focus on stabilizing our patients with co-morbidities may be why we are seeing longer stays with the hospitalist group,” Dr. Cipolle said. “Of course, the very good news is that there is a lower rate of mortality and trauma-related readmissions for this group.”

At Christiana Care, eight hospitalists rotate in weeklong shifts, and they are highly visible to patients, who, in the study, had an average age of 72. While trauma surgeons manage a patient’s pain and injury-related care, the hospitalists are active in attending to illnesses such as coronary artery disease, ischemic stroke and delirium. Although there is not yet enough data to say conclusively, evidence suggests greater patient satisfaction because of the multidisciplinary team approach, he said.

Dr. Cipolle said he is grateful to LeRoi S. Hicks, M.D., MPH, vice chair of the Department of Medicine, for being a strong advocate of bringing together trauma surgeons and hospitalists in the collaborative effort. He also praised Dr. Meyer for her key role in establishing the program. And from Dr. Meyer’s perspective, Robert M. Dressler, M.D., MBA, vice chair, Department of Medicine, and Edmondo J. Robinson, M.D. MBA, MSHP, SFHM, FACP, chief transformation officer, were instrumental in making the program a reality.

“To my knowledge no one has done quite what we’ve done by incorporating hospitalists and, nationally, there is interest in our results,” Dr. Cipolle said. “One reason is because older Delawareans are hospitalized for injury four or five times the rate that this population is growing.”

With the assistance of the Value Institute, Dr. Cipolle and his research team submitted a paper on the study for The Journal of Trauma and Acute Care Surgery, and Dr. Meyer is collaborating with the Value Institute on a paper for the Journal of Hospital Medicine. Follow-up research will include a cost-analysis study of the program.

Delaware’s Level 1 trauma center

Christiana Care Health System is the only Level 1 trauma center that serves both adults and children for people who live between Philadelphia and Baltimore, as well as within the entire state of Delaware. As a Level 1 trauma center, you can trust that all of our services for injured patients, from admission to discharge, are at the highest capability of care for both adult and pediatric patients.

Delaware is unique among a handful of states that have an all-inclusive trauma system linked statewide. This network of caregivers offers around-the-clock medical care for seriously injured people across the state.

Traumatic injury is the No. 1 killer and disabler of people in Delaware between the ages of 1 and 44, and the No. 4 killer for all age groups combined.